Sterile handle for controlling a robotic surgical system from a sterile field

ABSTRACT

An implant for therapeutically separating bones of a joint has two endplates each having an opening through the endplate, and at least one ramped surface on a side opposite a bone engaging side. A frame is slideably connected to the endplates to enable the endplates to move relative to each other at an angle with respect to the longitudinal axis of the implant, in sliding connection with the frame. An actuator screw is rotatably connected to the frame. A carriage forms an open area aligned with the openings in the endplates. The openings in the endplates pass through the carriage to form an unimpeded passage from bone to bone of the joint. The carriage has ramps which mate with the ramped surfaces of the endplates, wherein when the carriage is moved by rotation of the actuator screw, the endplates move closer or farther apart.

RELATED APPLICATIONS

The present application is a continuation application of U.S. patentapplication Ser. No. 14/619,732, filed on Feb. 11, 2015 know U.S. Pat.No. 10,039,605), which claims priority to U.S. Provisional ApplicationNo. 61/938,423, filed Feb. 11, 2014 (expired); and U.S. ProvisionalApplication No. 61/950,550, filed Mar. 10, 2014 (expired), the contentsof each of which are hereby incorporated by reference in theirentireties.

BACKGROUND

Robotic-assisted surgical systems have been developed to improvesurgical precision and enable the implementation of new surgicalprocedures. For example, robotic systems have been developed to sense asurgeon's hand movements and translate them to scaled-downmicro-movements and filter out unintentional tremors for precisemicrosurgical techniques in organ transplants, reconstructions, andminimally invasive surgeries. Other robotic systems are directed totelemanipulation of surgical tools such that the surgeon does not haveto be present in the operating room, thereby facilitating remotesurgery. Feedback-controlled robotic systems have also been developed toprovide smoother manipulation of a surgical tool during a procedure thancould be achieved by an unaided surgeon.

However, widespread acceptance of robotic systems by surgeons andhospitals is limited for a variety of reasons. Current systems areexpensive to own and maintain. They often require extensive preoperativesurgical planning prior to use, and they extend the required preparationtime in the operating room. They are physically intrusive, possiblyobscuring portions of a surgeon's field of view and blocking certainareas around the operating table, such that a surgeon and/or surgicalassistants are relegated to one side of the operating table. Currentsystems may also be non-intuitive or otherwise cumbersome to use,particularly for surgeons who have developed a special skill or “feel”for performing certain maneuvers during surgery and who find that suchskill cannot be implemented using the robotic system. Finally, roboticsurgical systems may be vulnerable to malfunction or operator error,despite safety interlocks and power backups.

Spinal surgeries often require precision drilling and placement ofscrews or other implements in relation to the spine, and there may beconstrained access to the vertebrae during surgery that makes suchmaneuvers difficult. Catastrophic damage or death may result fromimproper drilling or maneuvering of the body during spinal surgery, dueto the proximity of the spinal cord and arteries. Common spinal surgicalprocedures include a discectomy for removal of all or part of a disk, aforaminotomy for widening of the opening where nerve roots leave thespinal column, a laminectomy for removal of the lamina or bone spurs inthe back, and spinal fusion for fusing of two vertebrae or vertebralsegments together to eliminate pain caused by movement of the vertebrae.

Spinal surgeries that involve screw placement require preparation ofholes in bone (e.g., vertebral segments) prior to placement of thescrews. Where such procedures are performed manually, in someimplementations, a surgeon judges a drill trajectory for subsequentscrew placement on the basis of pre-operative CT scans. Other manualmethods which do not involve usage of the pre-operative CT scans, suchas fluoroscopy, 3D fluoroscopy or natural landmark-based, may be used todetermine the trajectory for preparing holes in bone prior to placementof the screws. In some implementations, the surgeon holds the drill inhis hand while drilling, and fluoroscopic images are obtained to verifyif the trajectory is correct. Some surgical techniques involve usage ofdifferent tools, such as a pedicle finder or K-wires. Such proceduresrely strongly on the expertise of the surgeon, and there is significantvariation in success rate among different surgeons. Screw misplacementis a common problem in such surgical procedures.

Image-guided spinal surgeries involve optical tracking to aid in screwplacement. However, such procedures are currently performed manually,and surgical tools can be inaccurately positioned despite virtualtracking. A surgeon is required to coordinate his real-world, manualmanipulation of surgical tools using images displayed on a twodimensional screen. Such procedures can be non-intuitive and requiretraining, since the surgeon's eye must constantly scan both the surgicalsite and the screen to confirm alignment. Furthermore, procedural errorcan result in registration inaccuracy of the image-guiding system,rendering it useless, or even misleading.

Certain force feedback systems are used by surgeons in certainprocedures; however such systems have a large footprint and take upvaluable, limited space in the operating room. These systems alsorequire the use of surgical tools that are specially adapted for usewith the force feedback system, and the training required by surgeons tooperate such systems can be significant. Moreover, surgeons may not beable to use expertise they have developed in performing spinal surgerieswhen adapting to use of the current force feedback systems. Suchsystems, while precise, may require more surgical time and moreoperating room preparation time to ready placement of the equipment forsurgery. Thus, there is a need for systems, apparatus, and methods thatprovide enhanced precision in performing surgeries such as spinalsurgeries.

SUMMARY

Described herein are a sterile handle for use with a robotic surgicalsystem, for example, during spinal surgery. In certain embodiments, thesterile handle adds functionalities and an interface to existingsurgical tools such that the robotic system may be commanded from thesterile field during surgery. The sterile handle permits a user, such asa surgeon, to physically manipulate the location of the end-effector ofa robotic surgical system from a sterile field.

The sterile handle may include an input device that allows the user tolimit the movement of the end-effector, such as limiting the movement totranslations or rotations only.

The sterile handle may detect the presence of a user's hand. Thisensures the end-effector is only moved when the user manipulates thesterile handle and reduces the likelihood that the end-effector is movedunintentionally. For example, robotic surgical system may permit themovement of the end-effector only in circumstances when the presencedetector is activated (e.g., a hand of a surgeon is detected as presentbecause the surgeon is holding the sterile handle).

The sterile handle, in certain embodiments, is configured such that itmay be used in a sterile environment.

The design of the sterile handle, in certain embodiments, permits rapidmounting of the handle on a surgical tool.

The sterile handle may be designed to avoid tight spaces between variouscomponents of the handle, thereby simply the sterilization process.

The disclosed technology, in certain embodiments, includes a sterilehandle for use with a robotic surgical system.

The sterile handle may include a tightening sleeve comprising a hollowtubular structure having a first open end, said structure defining anaxis along which a portion of a surgical instrument guide may beinserted into the internal housing. The tightening sleeve may includetwo or more openings along a length of the tightening sleeve allowingthe tightening sleeve to mechanically flex under tension. The openingsmay be slot, holes, or perforations.

The sterile handle may include a sterile handle housing with a hollowtubular structure having a first open end, said structure defining anaxis along which the tightening sleeve may be inserted into the externalhousing.

In certain embodiments, the sterile handle includes a tightening nutcoupled to the sterile handle housing. The tightening nut may include athread on an interior of the tightening nut. The tightening nut may beconfigured to engage a thread on exterior of the tightening sleeve andthereby tighten the tightening sleeve such that a diameter of a portionof the tightening sleeve decreases and securely holds a portion of asurgical instrument guide inserted into the internal housing.

The sterile handle may include an electrical assembly that includes oneor more input devices for commanding the robotic surgical system. Theone or more input devices may be two or more buttons configured toenable a user to place the robotic surgical system in one of a rotationmode, a translation mode, or a combined translation and rotation mode.In certain embodiments, upon selection of a first button of the two ormore buttons, the robotic surgical system is in the rotation mode, uponselection of a second button of the two or more buttons, the roboticsurgical system is in the translation mode, and upon selection of boththe first and second buttons, the robotic surgical system is in thecombined translation and rotation mode.

The sterile handle may be ambidextrous such that it may be used oneither side of the operating table and/or such that the robotic surgicalsystem may be placed on either side of the operating table.

The sterile handle may be configured to be attached directly orindirectly to an end-effector of the robotic surgical system.

In certain embodiments, the robotic surgical system may be configured toallow robotically-assisted or unassisted positioning and/or movement ofthe sterile handle by a user with at least six degrees of freedom,wherein the six degrees of freedom are three degrees of translations andthree degrees of rotations.

In certain embodiments, the robotic surgical system may be configured toallow robotically-assisted or unassisted positioning and/or movement ofthe sterile handle by a user with at least four degrees of freedom,wherein the four degrees of freedom are two degrees of translations andtwo degrees of rotations.

The surgical instrument guide may be configured to hold and/or restrictmovement of a second surgical instrument therethrough. The surgicalinstrument may be a drill bit, tap, screw driver, screw-based implantand awl. The surgical instrument guide may be a drill guide and thesurgical instrument may be a drill bit.

The robotic surgical system may be for use in spinal surgery.

The sterile handle may be used in a sterile environment. The sterilehandle is at least one of completely or partially disposable.

In some implementations, the sterile handle includes one or more sensorsconfigured to detect a presence of a surgeon's hand in proximity to thesterile handle.

The disclosed technology, in certain embodiments, includes a method ofperforming surgery with a robotic surgical system. The method mayinclude moving a mobile cart transporting a robotic surgical systemcomprising a robotic arm in proximity to an operating table, wherein therobotic arm has an end effector with a sterile handle attached thereto.

In certain embodiments, the method includes stabilizing the mobile cart.The method may include maneuvering the robotic arm to a desired positionto align an axis defined by the surgical instrument guide at a desiredtrajectory in relation to a patient situation. In certain embodiments,the method includes fixing the position of the robotic arm (and,therefore, the position of the surgical instrument guide), andmaneuvering a surgical instrument in a manner that is constrained by thesurgical instrument guide. The method may further include maneuveringthe drill bit through the drill bit guide. In certain embodiments, themethod may include maneuvering the surgical instrument through thesurgical instrument guide.

In some implementations, stabilizing the mobile cart includes extractingone or more rigid legs on the mobile cart such that the mobile cartrests on the one or more rigid legs of the mobile cart. In someimplementations, stabilizing the mobile cart includes retracting one ormore wheels on the mobile cart such that the mobile cart rests on one ormore rigid legs of the mobile cart. In certain embodiments, prior tomaneuvering the robotic arm to a desired position, obtaining oraccessing a CT scan, 3D CT scan, fluoroscopy, 3D fluoroscopy, or naturallandmark-based image of the patient situation.

In some implementations, the sterile handle includes a printed circuitboard. The printed circuit board may include the one or more inputdevices. In some implementations, the sterile handle housing includesone or more ribs that engage one or more openings, respectively, on thetightening sleeve when the sterile handle housing is slide over thetightening sleeve, thereby preventing rotation around the axis of thehandle when a torque is applied thereto.

BRIEF DESCRIPTION OF THE FIGURES

The foregoing and other objects, aspects, features, and advantages ofthe present disclosure will become more apparent and better understoodby referring to the following description taken in conjunction with theaccompanying drawings, in which:

FIG. 1 is an illustration of an example robotic surgical system in anoperating room;

FIG. 2 is an illustration of an example configuration of a robotic armfor performing a surgical operation;

FIGS. 3A through 3C are illustrations of a surgical instrument guide anda sterile handle for use with a robotic surgical system;

FIG. 4 is an illustration of a cross-sectional view of an examplesterile handle with a tightening sleeve and a sterile handle housing;

FIG. 5 is an illustration of an example sterile handle for use with arobotic surgical system;

FIG. 6 is an illustration of an example system sterile handle and toolholder attached to a robotic arm;

FIG. 7 is an illustration of an example robotic surgical system with asterile handle;

FIG. 8 is an illustration of an example robotic surgical system;

FIG. 9 is a flowchart of an example method of performing surgery with arobotic surgical system;

FIGS. 10A-B are illustrations of an example sterile handle rotatingalong the axis of the sterile handle;

FIGS. 11A-C are illustrations of portions of an example sterile handlewith a rib that engages an opening on the tightening sleeve of thesterile handle;

FIG. 12A-C are illustrations of portions of an example sterile handlewith an integrated printed circuit board;

FIG. 13 shows a block diagram of an exemplary cloud computingenvironment; and

FIG. 14 is a block diagram of a computing device and a mobile computingdevice.

The features and advantages of the present disclosure will become moreapparent from the detailed description set forth below when taken inconjunction with the drawings, in which like reference charactersidentify corresponding elements throughout. In the drawings, likereference numbers generally indicate identical, functionally similar,and/or structurally similar elements.

DETAILED DESCRIPTION

FIG. 1 illustrates an example robotic surgical system in an operatingroom 100. In some implementations, one or more surgeons, surgicalassistants, surgical technologists and/or other technicians (e.g., 106a-c) perform an operation on a patient 104 using a robotic-assistedsurgical system. In the operating room 100 the surgeon may be guided bythe robotic system to accurately execute an operation. This may beachieved by robotic guidance of the surgical tools, including ensuringthe proper trajectory of the tool (e.g., drill or screw). In someimplementations, the surgeon defines the trajectory intra-operativelywith little or no pre-operative planning The system allows a surgeon tophysically manipulate the tool holder to safely achieve proper alignmentof the tool for performing crucial steps of the surgical procedure.Operation of the robot arm by the surgeon (or other operator) in forcecontrol mode permits movement of the tool in a measured, even mannerthat disregards accidental, minor movements of the surgeon. The surgeonmoves the tool holder to achieve proper trajectory of the tool (e.g., adrill or screw) prior to operation or insertion of the tool into thepatient 104. Once the robotic arm is in the desired position, the arm isfixed to maintain the desired trajectory. The tool holder serves as astable, secure guide through which a tool may be moved through or slidat an accurate angle. Thus, the disclosed technology provides thesurgeon with reliable instruments and techniques to successfully performhis/her surgery.

In some embodiments, the operation may be spinal surgery, such as adiscectomy, a foraminotomy, a laminectomy, or a spinal fusion. In someimplementations, the surgical robotic system includes a surgical robot102 on a mobile cart 114. The surgical robot 102 in the example shown inFIG. 1 is positioned in proximity to an operating table 112 withoutbeing attached to the operating table 112, thereby providing maximumoperating area and mobility to surgeons around the operating table 112and reducing clutter on the operating table 112. In alternativeembodiments, the surgical robot 102 (or cart) is securable to theoperating table 112. In certain embodiments, both the operating table112 and the cart 114 are secured to a common base to prevent anymovement of the cart or table 112 in relation to each other, even in theevent of an earth tremor.

The mobile cart 114 may permit a user (operator) 106 a, such as atechnician, nurse, surgeon, or any other medical personnel in theoperating room 100, to move the surgical robot 102 to differentlocations before, during, and/or after a surgical procedure. The mobilecart 104 enables the surgical robot 102 to be easily transported intoand out of the operating room 100. For example, a user 106 a may movethe surgical robot 102 into the operating room 100 from a storagelocation. In some implementations, the mobile cart 114 may includewheels, a track system, such as a continuous track propulsion system, orother similar mobility systems for translocation of the cart. The mobilecart 114 may include an attached or embedded handle for locomotion ofthe mobile cart 114 by an operator (e.g., user 106 a).

For safety reasons, the mobile cart 114 may be provided with astabilization system that may be used during a surgical procedureperformed with a surgical robot 102. The stabilization mechanismincreases the global stiffness of the mobile cart 114 relative to thefloor in order to ensure the accuracy of the surgical procedure. In someimplementations, the wheels include a locking mechanism that preventsthe cart 114 from moving. The stabilizing, braking, and/or lockingmechanism may be activated when the machine is turned on. In someimplementations, the mobile cart 114 includes multiple stabilizing,braking, and/or locking mechanisms. In some implementations, thestabilizing mechanism is electro-mechanical with electronic activation.The stabilizing, braking, and/or locking mechanism(s) may be entirelymechanical. The stabilizing, braking, and/or locking mechanism(s) may beelectronically activated and deactivated.

In some implementations, the surgical robot 102 includes a robotic armmounted on a mobile cart 114. An actuator may move the robotic arm. Therobotic arm may include a force control end-effector configured to holda surgical tool. The robot 102 may be configured to control and/or allowpositioning and/or movement of the end-effector with at least fourdegrees of freedom (e.g., six degrees of freedom, three translations andthree rotations, or four degrees of freedom, two translations and tworotations, or a variation thereof).

In some implementations, the robotic arm is configured to releasablyhold a surgical tool, allowing the surgical tool to be removed andreplaced with a second surgical tool. The system may allow the surgicaltools to be swapped without re-registration, or with automatic orsemi-automatic re-registration of the position of the end-effector.

In some implementations, the surgical system includes a surgical robot102, a tracking detector 108 that captures the position of the patientand different components of the surgical robot 102, and a display screen110 that displays, for example, real time patient data and/or real timesurgical robot trajectories.

In some implementations, a tracking detector 108 monitors the locationof patient 104 and the surgical robot 102. The tracking detector 108 maybe a camera, a video camera, an infrared detector, field generator andsensors for electro-magnetic tracking or any other motion detectingapparatus. In some implementation, based on the patient and robotposition, the display screen 110 displays a projected trajectory and/ora proposed trajectory for the robotic arm of robot 102 from its currentlocation to a patient operation site. By continuously monitoring thepatient 104 and robotic arm positions, using tracking detector 108, thesurgical system can calculate updated trajectories and visually displaythese trajectories on display screen 110 to inform and guide surgeonsand/or technicians in the operating room 100 using the surgical robot.In addition, in certain embodiments, the surgical robot 102 may alsochange its position and automatically position itself based ontrajectories calculated from the real time patient and robotic armpositions captured using the tracking detector 108. For instance, thetrajectory of the end-effector can be automatically adjusted in realtime to account for movement of the vertebrae and/or other part of thepatient 104 during the surgical procedure.

FIG. 2 illustrates an example configuration 200 of a robotic arm forperforming a surgical operation. The robotic surgical system includes arobotic arm 202 and an end-effector 204. The manipulator is configuredto allow robotically-assisted or unassisted positioning and/or movementof the surgical instrument guide 206 by a user with at least fourdegrees of freedom to align an axis defined by the instrument guide at adesired trajectory in relation to a patient situation. The axis can bealigned with the desired trajectory in relation to the patient situationvia the manipulator.

An end-effector, such as surgical instrument guide 206, is coupled tothe end-effector 204 for precisely guiding instruments during surgery.For example, the surgical instrument guide 206 may be coupled to themanipulator via a flange. The surgical instrument guide 206 isconfigured to hold and/or restrict movement of a surgical instrumenttherethrough. As shown in FIG. 2, in some implementations, the surgicalinstrument is a drill 218 and drill bit 208. In this exampleillustration, the surgical instrument guide 206 is a drill bit guide.Such a system may be used to perform spinal surgery. The surgical toolmay be, for example, a tap such as the StealthStation® CR Horizon LegacyTaps from Medtronic, Inc. of Minneapolis, Minn. Other surgicalinstruments may be used by the system, such as a screw driver,screw-based implant, or awl. For example, the surgical instrument guidemay be configured to be used to guide a screw implant and a tissueprotector.

FIGS. 3A through 3C are illustrations of a surgical instrument guide anda sterile handle for use with a robotic surgical system. In someimplementations, the sterile handle 302 includes a tightening sleeve 304with a hollow tubular structure having a first open end. In someimplementations, the structure of the tightening sleeve 304 defines anaxis along which a portion 322 of a surgical instrument guide 320 may beinserted into the tightening sleeve 304. The portion 322 of the surgicalinstrument guide 320 that may be inserted into the tightening sleeve 304may be a separate component (e.g., a handle) that can be mechanicallyattached to the surgical instrument guide 320. In some implementations,portion 322 of the surgical instrument guide 320 that may be insertedinto the tightening sleeve 304 is an integrated component of thesurgical instrument guide 320. In some implementations, a navigationtracker 324 is coupled to the surgical instrument guide 320 such thatthe position of the surgical instrument guide 320 may be tracked by anavigation system (e.g., tracking camera) of the robotic surgicalsystem.

A sterile handle housing 306 may include a hollow tubular structurehaving a first open end. The sterile handle housing 306 structure maydefine an axis along which the tightening sleeve 304 may be insertedinto the sterile handle housing 306.

The tightening sleeve 304 may include two or more openings 308 along alength of the tightening sleeve allowing the tightening sleeve tomechanically flex under tension. In some implementations, the two ormore openings are two or more slots, holes, or perforations.

A tightening nut 312 may be permanently and removably coupled to thesterile handle housing 306. The tightening nut 312 includes a thread onan interior of the tightening nut. The tightening nut 312 is configuredto engage a thread 310 on exterior of the tightening sleeve 304 andthereby tighten the tightening sleeve 304 such that a diameter of aportion of the tightening sleeve decreases and securely holds a portion322 of a surgical instrument guide 320 inserted into the tighteningsleeve 304. The tightening sleeve 304 includes a wedge 314 that engagesa wedge on the interior of the sterile handle housing 306 as thetightening nut 312 is tightened and the threads inside the tighteningnut 312 engage the threads 310 on the tightening sleeve 304 and pull thetightening sleeve in the direction of the tightening nut 312. The wedgesforce the tightening sleeve to flex and increase the friction betweenthe portion 322 of the surgical instrument holder 320 and the tighteningsleeve 304 when the sterile handle 302 is assembled with the portion 322of the surgical instrument holder 320 inserted into the tighteningsleeve 304. Thus, tightening the tightening nut 312 enables the sterilehandle to securely hold the surgical instrument guide.

In some implementations, the sterile handle 302 includes an electricalassembly 316. The electrical assembly 316 may include one or more inputdevices 318 for commanding the robotic surgical system. The one or moreinput devices 318 may include two or more buttons 318 a and 318 bconfigured to enable a user to place the robotic surgical system in oneof a rotation mode, a translation mode, or a combined translation androtation mode. In some implementations, upon selection of a first button318 a of the two or more buttons, the robotic surgical system is in therotation mode, upon selection of a second button 318 b of the two ormore buttons, the robotic surgical system is in the translation mode,and upon selection of both the first and second buttons 318 a-b, therobotic surgical system is in the combined translation and rotationmode. In some implementations, the handle 302 and input device(s)thereon (e.g., buttons) can be used for instructing the robotic systemto translate along a line when the translation button is pressed, rotatearound the line if the rotation button is pressed, and/or translate androtate around the line if both buttons are pressed.

The electrical assembly 316 may be directly integrated into the sterilehandle 302. In some implementations, the electrical assembly 316 can bedone separately (e.g., using over-molding on buttons and cable or epoxyresin to form an assembly which is integrated into the handle using arapid locking mechanism).

In some implementations, the sterile handle 302 is ambidextrous. In someimplementations, the sterile handle 302 is configured such that arobotic surgical system may be used on either side of an operating tablewhen the handle 302 is in use. The sterile handle 302 is configured tobe attached directly or indirectly to an end-effector of the roboticsurgical system. In some implementations, the robotic surgical system isconfigured to allow robotically-assisted or unassisted positioningand/or movement of the sterile handle by a user with at least sixdegrees of freedom. The six degrees of freedom may be three degrees oftranslations and three degrees of rotations.

As described above, the sterile handle 302 is configured to securelyhold a surgical instrument guide 320. The surgical instrument guide 320is configured to hold and/or restrict movement of a surgical instrumenttherethrough. The surgical instrument may be a drill bit, tap, screwdriver, screw-based implant, or awl. In some implementations, thesurgical instrument guide 320 is a drill guide and the surgicalinstrument is a drill bit. In some implementations, the robotic surgicalsystem is for use in spinal surgery.

The sterile handle 302 may be completely or partially disposable. Forexample, in some implementations, the electrical assembly 316 may bedisposable. All disposable parts may be produced in molded plastic. Insome implementations, reusable parts may be made of either metal orplastic. In some implementations, the entire sterile handle 302 isreusable. Assembly of the sterile handle 302 may be performedpre-operatively. For example, a disposable sterile handle 302 may becompletely assembled in the packaging. In some implementations, thesterile handle 302 may be assembled intra-operatively. In someimplementations, the electrical assembly 316 may be fixed in the handlebefore mounting the sterile handle 302 on the surgical instrument 320.

The sterile handle 302 may be made of a sterile material or a materialthat may be sterilized. In some implementations, the sterile handle 302may be sterilized using different technologies, such as using EthyleneOxide (EtO), autoclave, radiation, or other sterilization methods.Different components of the sterile handle 302 using differenttechnologies, for example, mechanical assembly in an autoclave,electrical assembly in an EtO. In some implementations, sterilization isachieved by draping. In some implementations, the sterile handlecomprises one or more sensors configured to detect a presence of asurgeon's hand in proximity to the sterile handle. In someimplementations, the one or more sensors include a presence mechanism332 that is engaged by a surgeon's hand when the surgeon holds thehandle such that presence of the hand is detected. The presencemechanism may be a lever-button mechanism. In some implementations, thepresence mechanism 332 includes one or more capacitive or resistivesensors, or a combination thereof.

FIG. 3B illustrates a handle 322 of a surgical instrument guide 320 withthe tightening sleeve 304 of a sterile handle 302 slide over the handle322. The sterile handle housing 306 is shown adjacent the tighteningsleeve 304 and may be slide over the tightening sleeve 304. FIG. 3Cillustrates a handle 322 of a surgical instrument guide 320 with thetightening sleeve 304 of a sterile handle 302 slide over the handle 322and the sterile handle housing 306 slide over the tightening sleeve 304.As the tightening nut 312 is tightened, the body of the tighteningsleeve 304 is pinched, thus increasing the friction between the handle322 and the tightening sleeve 304 and securing the handle 322 within thetightening sleeve 304.

FIG. 4 illustrates a cross-sectional view of an example sterile handle400 with a tightening sleeve 408 and a sterile handle housing 406. Asurgical instrument guide 420 (e.g., a handle of a surgical instrumentguide), may slide into the tightening sleeve 408. As a user tightens thetightening nut 412, threads 414 (e.g., threads on the sterile handlehousing 406 and threads on the tightening sleeve 408) cause thetightening sleeve 408 to pull/slide towards the tightening nut 412(e.g., towards the right as shown in FIG. 4).

The internal housing, in some implementations, includes openings 410(e.g., slots, holes, or perforations) that allow a portion of the bodyof the tightening sleeve 408 to be pinched. As the tightening nut 412 istightened, a wedge 416 causes a portion of the body of the tighteningsleeve 408 to be pinched. As shown in FIG. 4, as the tightening sleeveslides to the right, a wedge on the sterile handle housing 406 contactsa wedge on the tightening sleeve 408, thus a portion of the body of thetightening sleeve 408 is pinched. When a surgical instrument guide 420is inserted into an assembled handle 400 and the tightening nut 412 istightened, the tightening sleeve 408 “grips” the surgical instrumentguide 420 (e.g., the friction between the guide 420 and the tighteningsleeve 408 is increased). Thus, the surgical handle 400 securely holdsthe guide 420.

FIG. 5 is an illustration of an example sterile handle for use with arobotic surgical system. In some implementations, the sterile handle 502includes an electrical assembly 516. The electrical assembly 516 mayinclude one or more input devices 518 for commanding the roboticsurgical system. The one or more input devices 518 may include two ormore buttons 518 a and 518 b configured to enable a user to place therobotic surgical system in one of a rotation mode, a translation mode,or a combined translation and rotation mode. In some implementations,upon selection of a first button 518 a of the two or more buttons, therobotic surgical system is in the rotation mode, upon selection of asecond button 518 b of the two or more buttons, the robotic surgicalsystem is in the translation mode, and upon selection of both the firstand second buttons 518 a-b, the robotic surgical system is in thecombined translation and rotation mode. In some implementations, theelectrical assembly 516 is integrated into a housing of the sterilehandle 502. In some implementations, the electrical assembly 516 isremovable. The handle 502 may include a rapid locking mechanism 534 thatis used to attach the electrical assembly 516 to the handle 502. Theelectrical assembly 516 may include a wire 530 that is used to connectto the electrical system of the robotic surgical system. In someimplementations, the wire 530 includes a plug that plugs into anembedded connector in a sterile drape (e.g., drape connector).

In some implementations, the sterile handle comprises one or moresensors configured to detect the presence of a surgeon's hand inproximity to the sterile handle. In some implementations, the one ormore sensors include a mechanism 332 that is engaged by a surgeon's handwhen the surgeon holds the handle such that presence of the hand isdetected.

FIG. 6 illustrates an example system 600 sterile handle and tool holderattached to a robotic arm. In some implementations, the system 600includes a sterile drape 602 for covering a surgical robotic arm 604 andpreventing contamination of a sterile field.

In some implementations, the sterile drape 602 includes a flexiblecovering with a sterile outer surface. The sterile drape may bepartially conformable to a surgical robotic arm. The sterile drape mayinclude an embedded connector 608 configured (e.g., positioned on theflexible covering and sized) to permit electrical contact between thesurgical robotic arm 604 (e.g., an actuator of the robotic arm) and asterile manipulator 606 (e.g., sterile handle) of the robotic arm 604when the sterile manipulator 606 is separated from the surgical roboticarm by the flexible covering. In some implementations, the sterile drape602 is disposable (e.g., a single-use product).

The drape connector 608 may be configured to couple to a handleconnector 610 that is connected to the sterile handle 606. The drapeconnector 608 may also be configured to couple to a robot connector 612that is connected to the electrical system of the robotic surgicalsystem. Thus, the drape connector may act as an intermediary connectorthat allows the handle to be electrically connected to the electricalsystem of the robotic surgical system through the sterile drape 602.

FIG. 7 is an illustration of an example robotic surgical system 700 witha sterile handle 710. In some implementations, the robotic surgicalsystem is for performing surgery, such as spinal surgery. The roboticsurgical system may include a robotic arm 714 with an interface 702 forengaging a sterile adapter 706. The sterile adapter 706 may beconfigured to attach to the robotic arm 714 via a robotic interface 706and tightly stretch the sterile drape 704 to assure repeatable and rigidpositioning of the sterile drape 704. The sterile drape 704 may beconfigured to protect the robotic arm from contaminating a sterilefield. In some implementations, the sterile drape includes a drapeconnector configured to electrically couple, through the sterile drape,the manipulator to an electrical system of the robotic surgical systemcovered by the sterile drape. The sterile handle 710 may be coupled to ahandle connector via a cable and the handle connector is configured toelectrically connect to the drape connector. The electrical system ofthe robotic surgical system may be coupled to a robot connector and therobot connector may be configured to electrically connect to the drapeconnector. Thus, the robot connector may electrically couple the drapeconnector to the robot connector, through the sterile drape 704.

In some implementations, a surgical instrument holder 718 is configuredto securely hold the surgical instrument 708. The surgical instrumentholder 718 may be attached to the interface 702 via a tightening screw716. The tightening screw 716 may protrude through the sterile drape 704that is tightly stretched over the opening of the sterile adapter 706.The robot interface 702 may include one or more positioning elements 712(e.g., pegs or pins) configured to provide accurate and repeatablepositioning of the surgical instrument holder 714 in reference to therobotic arm. The one or more positioning elements 712 may be round oroblong. The surgical instrument holder 718 may include one or more studsor holes that engage the one or more positioning elements 712. The oneor more positioning elements 712 may protrude through the sterile drape704 when the sterile adapter 706 is attached to the interface 702. Insome implementations, the one or more positioning elements 712 extendfrom the robotic arm 714 and engage one or more surgical instrumentholder positioning members. For example, the one or more positioningelements 712 may be the one or more pegs are configured to extend fromthe robotic arm and engage one or more holes in the surgical instrumentholder 718.

In some implementations, the robotic surgical system includes amanipulator 710 (e.g., a sterile handle) configured to allowrobotically-assisted or unassisted positioning and/or movement of thesurgical instrument by a user with at least four degrees of freedom toalign an axis defined by the surgical instrument at a desired trajectoryin relation to a patient situation.

In some implementations, the surgical instrument is a surgicalinstrument guide configured to hold and/or restrict movement of a secondsurgical instrument there through. The second surgical instrument may bea drill bit, tap, screw driver, screw-based implant, or awl. Forexample, in the case of spinal surgery, the second surgical instrumentmay be a drill bit and the surgical instrument guide may be a drillguide.

In some implementations, the robotic surgical system includes a mobilecart configured to transport the robotic surgical system. The steriledrape may be configured to protect the mobile cart from contaminating asterile field. In some implementations, the sterile drape includes afirst sterile drape to protect the robotic arm 714 and a second steriledrape to protect the mobile cart. In some implementations, the steriledrape may include printed marks configured to assist in proper drapingprocedure. In some implementations, the drape may be folded in aconfiguration that makes for easily applying the drape to the roboticsystem.

In some implementations, the surgical instrument holder is configured tobe attached to the robotic arm using a fastening system. The fasteningsystem may be a bolt, nut, screw, or one or more electro magnets.

In some implementations, one or more holding stripes are configured tohold the sterile drape. The one or more holding stripes may secure aportion of the sterile drape to the robotic arm. In someimplementations, the system includes a suppression system configured toremove air from under the sterile drape. The suppression system mayinclude a ventilator or a suction device that pumps out the air fromunder the sterile drape.

In some implementations, the surgical instrument holder 714 is made froma non-conductive material (e.g., plastic). The holder 718 may act as aninsulator (prevent electrical conductivity) between the surgicalinstrument 708 and the robotic arm 714. In some implementations, thesurgical instrument holder 718 is conductive, however, a non-conducivepad is placed between the holder 718 and the interface 702.

FIG. 8 is an illustration of an example robotic surgical system. In someimplementations, one or more surgeons, surgical assistants, surgicaltechnologists and/or other technicians, perform an operation on apatient using a robotic-assisted surgical system. In the operating roomthe surgeon may be guided by the robotic system to accurately execute anoperation. The robotic surgical system may be transported in and out ofan operating room using a mobile cart (not shown). Accordingly, therobotic surgical system, including the mobile cart, must be sterilizedwhen used in the operating room. The system may be sterilized byapplying a sterile drape 820 to a portion of the system, including therobotic arm 802 and/or the mobile cart. The sterile drape 820 mayconsist of a single drape or several pieces, such as a sterile cover forcovering the robotic arm 802 and a sterile drape for covering the mobilecart.

In some implementations, the sterile drape 820 is attached (e.g., gluedor welded) to a sterile adapter 822. The sterile adapter 822 may beattached (e.g., clipped) to a tool holder body 824 on the robotic arm802. The sterile adapter 822 ensures the drape 820 is tightly stretchedover the tool holder 824 to protect the robotic arm 802 and mobile cartfrom contaminating the sterile field, and provides a structure thatprovides for repeatable and rigid positioning of the sterile drape.Tightly stretching the drape 820 between the instrument holder 826 andtool holder 824 and tightening the instrument holder 826 to the roboticarm 802 using, for example, a tightening screw 832, reduces thelikelihood of folds in the drape between the told holder and robotinterface. Thus, errors between the robot model and the actual situationbecause of the position of the tool holder relative to the robotinterface are minimized. If folds are present, the positioning of theinstrument holder 826 relative to the robot interface will be differentthan anticipated and the robotic surgical system may have difficultypositioning tools held by the tool holder appropriately.

A sterile tool holder 826 may be connected to the robotic arm 802through the sterile drape 820. In some implementations, the instrumentholder 826 includes a base 828, clamp 830, and nut 832. In someimplementations, the nut is tightened to pull the clamp 830 closer tothe base 828 such that a surgical instrument, such as tool guide 814 issecurely held between the base 828 and the clamp 830. The instrumentholder 826 be coupled to a navigation marker 816. A sterile handle 804may be mechanically coupled to the tool guide 814 via a handle 818 ofthe tool guide. A tightening nut 808 on the sterile handle 804 may beused to tighten the sterile handle to the handle 818 such that thesterile handle 804 is securely attached to the handle 818.

In some implementations, the sterile handle 804 includes an input device806, such as button 806 a and button 806 b, that enables a user tocontrol the position of the end effector 820. Thus, the disclosedtechnology enables a robotic surgical system to be used in a sterileoperating room without having to sterilize each individual component ofthe system. Only the components outside of the sterile drape (e.g., theoptical mark, surgical instruments, and tool holder must be sterilizedindividually.

The input device 806 may mimic the functionality of the mode selectionpanel 838. Both the input device 806 and the mode selection panel 838.In some implementations, both of these interfaces are configured toenable a user to place the robotic surgical system in one of a rotationmode, a translation mode, or a combined translation and rotation mode.In some implementations, upon selection of a first button of the two ormore buttons, the robotic surgical system is in the rotation mode, uponselection of a second button of the two or more buttons, the roboticsurgical system is in the translation mode, and upon selection of boththe first and second buttons, the robotic surgical system is in thecombined translation and rotation mode.

In some implementations, the sterile adapter 822 may be a disposable(e.g. a single-use product). For example, a new sterile adapter 822 maybe used for every surgical procedure. In some implementations, thesterile adapter 822 is a rigid or semi-rigid device. It may be made froma hard plastic, polymer, or a composite material. In someimplementations, the sterile adapter 822 secures a drape 820 over asurgical robotic arm 802 to prevent contamination of a sterile field.

The sterile adapter 822 may include a rigid or semi-rigid collar (e.g.,ring or a hollow cylindrical structure) configured to mount (e.g.,snap-mount) onto an interface 824 of the surgical robotic arm. Thesterile adapter 822 may include a rigid or semi-rigid body extendingfrom the collar and shaped to conform to a portion of the surgicalrobotic arm to tightly secure a flexible drape 820 in place (e.g., withno folds) over the portion of the surgical robotic arm 802 when thedrape 820 is attached to the adapter 822.

In some implementations, the sterile adapter 822 is one or more tabsthat engage an interface on the robot. The tabs may “click” into theinterface to provide easy and secure mounting of the sterile adapter822, and hence sterile drape 820, on the robot. The sterile drape 820may be glued or welded to the sterile adapter 822. The adapter 822ensures that the drape is tightly stretched over the instrument holder826 and tool holder body 824 to provide repeatable and rigid positioningof the instrument holder 826 relative to the robotic arm 802.

In some implementations, a user applies forces and torques on aninstrument guide 814 attached to a force/torque sensor 834. Theforce/torque sensor 834 may be attached to a flange on the robot arm 802and measures the forces and torques applied to the tool, such as guide814. In some implementations, the measurements are transmitted to aforce control box. In some implementations, the force control boxconverts the analog data into digitized data and transmits them to acontroller. In some implementations, the measurements from force/torquesensor 834 are sent directly to the controller. The controller processesthe forces and torques and computes linear and angular correction of theend-effector 840 position of the robot. The controller sends commands tothe motors of the robot to update the position of the end effector 840to a set point position. The controller may check the current positionof the position of the end-effector 840 and stops sending commands tothe motors if the set point position is reached. In someimplementations, this process is performed continuously. In someimplementations, the motors are servo or electric motors that arecontrolled by a servo control. The force sensor 834 may be connected tothe robot with an intermediary analog box which measures forces andtorques and transmits them via a network (e.g., Ethernet, CAN, wireless,internet, private LAN, public LAN, etc.).

The force sensor 834 may be attached to system in a variety ofconfigurations. In some implementations, the force sensor 834 is coupledto the robot arm 802 using a sensor-robot interface 836. The tool holderbody 824 may be coupled to the robotic arm 802 via the force sensor 834.Using this configuration, the sterile cover 820 may be wrapped aroundthe robot arm 802 and between the tool holder body 824 and theinstrument holder 826 via the sterile adapter 828 to ensuresterilization. The force sensor 834 may provide for direct measurementof forces on the tool. The force sensor 834 may be designed to resistflexing. The force sensor 834 may be designed to flex under the stressof certain external forces. The displacement caused when an externalforce is applied may be calculated based on the force applied to thetool, torque applied to the tool, radial force stiffness, axial torquestiffness, and the diameter of the holder to which the tool is attached.In some implementations, the force sensor 834 is located between thetool holder 826 and robot tool holder body 824.

In some implementations, the sterile drape 820 includes a flexiblecovering with a sterile outer surface. The covering 820 may be at leastpartially conformable to a surgical robotic arm 802. The sterile drape820 may include an embedded connector configured (e.g., positioned onthe flexible covering and sized) to permit electrical contact betweenthe electronics for controlling the surgical robotic arm (e.g., anactuator of the robotic arm) and the electronics of a sterile handle 804of the robotic arm 802 when the sterile handle 804 is separated from thesurgical robotic arm 802 by the flexible covering 820. In someimplementations, the sterile drape 820 is disposable (e.g., a single-useproduct). In some implementations, the sterile handle 804 is connectedto a handle connector 812 via a cable 810. The handle connector 812 maybe plugged into or electrically coupled to the embedded connector of thesterile drape 820. In some implementations, an electrical connector iscoupled to the electrical system of the robotic surgical system and maybe electrically coupled to the embedded connector of the sterile drape820 such that the handle connector 812 and the electrical connector areelectrically coupled to each other through the sterile drape (e.g., viathe embedded connector in the drape).

FIG. 9 is a flowchart of an example method 900 of performing surgerywith a robotic surgical system. In some implementations, the method 900includes moving a mobile cart transporting a robotic surgical systemwith a robotic arm in proximity to an operating table (902). In someimplementations, the robotic arm has an end effector and a sterilehandle thereto. In some implementations, the sterile handle includes atightening sleeve with a hollow tubular structure having a first openend. The structure may define an axis along which a portion of asurgical instrument guide may be inserted into the internal housing. Thetightening sleeve may include two or more openings along a length of thetightening sleeve allowing the tightening sleeve to mechanically flexunder tension The two or more openings may be slots, holes,perforations, or a combination thereof.

In some implementations, the sterile handle includes a sterile handlehousing with a hollow tubular structure having a first open end, saidstructure defining an axis along which the tightening sleeve may beinserted into the external housing. In some implementations, the sterilehandle includes a tightening nut coupled to the sterile handle housing.The tightening nut may include a thread on an interior of the tighteningnut and the tightening nut may be configured to engage a thread onexterior of the tightening sleeve and thereby tighten the tighteningsleeve such that a diameter of a portion of the tightening sleevedecreases and securely holds a portion of a surgical instrument guideinserted into the internal housing. The portion of the surgicalinstrument guide inserted into the tightening sleeve may be a portion ofthe surgical instrument guide handle.

In some implementations, the sterile handle includes an electricalassembly with one or more input devices for commanding the roboticsurgical system. The one or more input devices may include two or morebuttons configured to enable a user to place the robotic surgical systemin one of a rotation mode, a translation mode, or a combined translationand rotation mode. In some implementations, upon selection of a firstbutton of the two or more buttons, the robotic surgical system is in therotation mode, upon selection of a second button of the two or morebuttons, the robotic surgical system is in the translation mode, andupon selection of both the first and second buttons, the roboticsurgical system is in the combined translation and rotation mode.

In some implementations, the method 900 includes stabilizing the mobilecart (904). Stabilizing the mobile cart may include extracting one ormore rigid legs on the mobile cart such that the mobile cart rests onthe one or more rigid legs of the mobile cart. In some implementations,stabilizing the mobile cart includes retracting one or more wheels onthe mobile cart such that the mobile cart rests on one or more rigidlegs of the mobile cart.

In some implementations, the method 900 includes maneuvering the roboticarm to a desired position to align an axis defined by the surgicalinstrument at a desired trajectory in relation to a patient situation(906). The desired trajectory may be a desired path of the surgicalinstrument guide. In some implementations, the method 900 includes,prior to maneuvering the robotic arm to a desired position, obtaining oraccessing a CT scan, 3D CT scan, fluoroscopy, 3D fluoroscopy, or naturallandmark-based image of the patient situation.

In some implementations, the method 900 includes, after maneuvering therobotic arm to the desired position, fixing the position of the roboticarm (and, therefore, the position of the surgical instrument) (908). Insome implementations, the method 900 includes, after fixing the positionof the robotic arm, maneuvering the surgical instrument guide in amanner that is constrained by the surgical instrument guide (910). Insome implementations, the surgical instrument guide is configured tohold and/or restrict movement of a second surgical instrumenttherethrough. The surgical instrument may be a drill bit, tap, screwdriver, screw-based implant, and awl. In some implementations, thesurgical instrument guide is a drill guide and the surgical instrumentis a drill bit. Step 910 may include maneuvering the surgical instrumentthrough the surgical instrument guide. For example, step 910 may includemaneuvering the drill bit through the drill bit guide. In someimplementations, the robotic surgical system is for use in spinalsurgery.

In some implementations, the sterile handle includes one or more sensorsconfigured to detect a presence of a surgeon's hand in proximity to thesterile handle. The sensor may include a button or lever that isactivated when a user grabs a portion of the sterile handle, thusalerting the system that the hand is present. This may allow the systemto detect intentional movements of the robotic arm and/or end effect andunintentional movements which may be avoided or negated by the system(e.g., such that the end effector or arm does not move).

In some implementations, features are added to the sterile handle toprevent rotation of the handle about the axis of the handle when atorque is applied thereto as shown in FIGS. 10A-B. In someimplementations, one or more ribs 1102 are added to the external housing1104 of the sterile handle 1100 (e.g., on the inner surface of theexternal housing) as shown in FIGS. 11A-C (various cross-sectional viewsof portions of the sterile handle are shown therein). The one or moreribs 1102 are designed to block rotation along the axis of the sterilehandle 1100 by engaging one or more openings 1108, respectively, in theinternal housing 1106 of the sterile handle 1100. In the example shownin FIGS. 11A-C, the rib 1102 engages the opening 1108 when the externalhousing 1104 is slide over the internal housing 1106. In someimplementations, several ribs (e.g., two, three, four, five, or sixribs) are integrated in the external housing 1104 (e.g., and at least acorresponding number of openings in the internal housing 1106), therebydecreasing the load on a single rib when a torque is applied to thehandle 1100. This allows, for example, a user to apply high torquesaround the axis of the handle without rotating the handle itself.

In some implementations, the materials used in the design of the handleare such that the friction between the inner and outer housing of thesterile handle as explained above is such that rotation of the axis isprevented (e.g., without using one or more ribs). In someimplementations, interface between the inner and outer housings iscoated or textured to increase the friction there between, therebypreventing the undesired rotation.

FIGS. 12A-C illustrate portions of an example sterile handle. In certainembodiments, the buttons 1218 a-b (e.g., buttons 318 a-b shown in FIG.3A) are connected to a printed circuit board housed at least partiallyinside the sterile handle. In some implementations, the printed circuitboard is part of the sterile handle housing (i.e., external housing). Insome implementations, the printed circuit board is part of thetightening sleeve (i.e., the internal housing of the sterile handle).The printed circuit board (e.g., and the buttons 1218), in someimplementations, are preassembled (e.g., prior to assembling thehandle). In some implementations, a switch 1218 c is included such asswitch 332 as described in relation to FIG. 3A. In some implementations,the sterile handle (e.g., the input devices on the sterile handle andthe movement detection device) are electrically connected to a plug 1206via a cable 1204. The plug 1206 may be connected to the computer of therobotic surgical system thereby enabling the computer to communicatewith the sterile handle and vice versa. In some implementations, a cableconnector 1202 is included on the printed circuit board as shown in FIG.12C.

As shown in FIG. 13, an implementation of a network environment 1300 foruse with a robotic surgical system is shown and described. In briefoverview, referring now to FIG. 13, a block diagram of an exemplarycloud computing environment 1300 is shown and described. The cloudcomputing environment 1300 may include one or more resource providers1302 a, 1302 b, 1302 c (collectively, 1302). Each resource provider 1302may include computing resources. In some implementations, computingresources may include any hardware and/or software used to process data.For example, computing resources may include hardware and/or softwarecapable of executing algorithms, computer programs, and/or computerapplications. In some implementations, exemplary computing resources mayinclude application servers and/or databases with storage and retrievalcapabilities. Each resource provider 1302 may be connected to any otherresource provider 1302 in the cloud computing environment 1300. In someimplementations, the resource providers 1302 may be connected over acomputer network 1308. Each resource provider 1302 may be connected toone or more computing device 1304 a, 1304 b, 1304 c (collectively,1304), over the computer network 1308.

The cloud computing environment 1300 may include a resource manager1306. The resource manager 1306 may be connected to the resourceproviders 1302 and the computing devices 1304 over the computer network1308. In some implementations, the resource manager 1306 may facilitatethe provision of computing resources by one or more resource providers1302 to one or more computing devices 1304. The resource manager 1306may receive a request for a computing resource from a particularcomputing device 1304. The resource manager 1306 may identify one ormore resource providers 1302 capable of providing the computing resourcerequested by the computing device 1304. The resource manager 1306 mayselect a resource provider 1302 to provide the computing resource. Theresource manager 1306 may facilitate a connection between the resourceprovider 1302 and a particular computing device 1304. In someimplementations, the resource manager 1306 may establish a connectionbetween a particular resource provider 1302 and a particular computingdevice 1304. In some implementations, the resource manager 1306 mayredirect a particular computing device 1304 to a particular resourceprovider 1302 with the requested computing resource.

FIG. 14 shows an example of a computing device 1400 and a mobilecomputing device 1450 that can be used to implement the techniquesdescribed in this disclosure. The computing device 1400 is intended torepresent various forms of digital computers, such as laptops, desktops,workstations, personal digital assistants, servers, blade servers,mainframes, and other appropriate computers. The mobile computing device1450 is intended to represent various forms of mobile devices, such aspersonal digital assistants, cellular telephones, smart-phones, andother similar computing devices. The components shown here, theirconnections and relationships, and their functions, are meant to beexamples only, and are not meant to be limiting.

The computing device 1400 includes a processor 1402, a memory 1404, astorage device 1406, a high-speed interface 1408 connecting to thememory 1404 and multiple high-speed expansion ports 1410, and alow-speed interface 1412 connecting to a low-speed expansion port 1414and the storage device 1406. Each of the processor 1402, the memory1404, the storage device 1406, the high-speed interface 1408, thehigh-speed expansion ports 1410, and the low-speed interface 1412, areinterconnected using various busses, and may be mounted on a commonmotherboard or in other manners as appropriate. The processor 1402 canprocess instructions for execution within the computing device 1400,including instructions stored in the memory 1404 or on the storagedevice 1406 to display graphical information for a GUI on an externalinput/output device, such as a display 1416 coupled to the high-speedinterface 1408. In other implementations, multiple processors and/ormultiple buses may be used, as appropriate, along with multiple memoriesand types of memory. Also, multiple computing devices may be connected,with each device providing portions of the necessary operations (e.g.,as a server bank, a group of blade servers, or a multi-processorsystem).

The memory 1404 stores information within the computing device 1400. Insome implementations, the memory 1404 is a volatile memory unit orunits. In some implementations, the memory 1404 is a non-volatile memoryunit or units. The memory 1404 may also be another form ofcomputer-readable medium, such as a magnetic or optical disk.

The storage device 1406 is capable of providing mass storage for thecomputing device 1400. In some implementations, the storage device 1406may be or contain a computer-readable medium, such as a floppy diskdevice, a hard disk device, an optical disk device, or a tape device, aflash memory or other similar solid state memory device, or an array ofdevices, including devices in a storage area network or otherconfigurations. Instructions can be stored in an information carrier.The instructions, when executed by one or more processing devices (forexample, processor 1402), perform one or more methods, such as thosedescribed above. The instructions can also be stored by one or morestorage devices such as computer- or machine-readable mediums (forexample, the memory 1404, the storage device 1406, or memory on theprocessor 1402).

The high-speed interface 1408 manages bandwidth-intensive operations forthe computing device 1400, while the low-speed interface 1412 manageslower bandwidth-intensive operations. Such allocation of functions is anexample only. In some implementations, the high-speed interface 1408 iscoupled to the memory 1404, the display 1416 (e.g., through a graphicsprocessor or accelerator), and to the high-speed expansion ports 1410,which may accept various expansion cards (not shown). In theimplementation, the low-speed interface 1412 is coupled to the storagedevice 1406 and the low-speed expansion port 1414. The low-speedexpansion port 1414, which may include various communication ports(e.g., USB, Bluetooth®, Ethernet, wireless Ethernet) may be coupled toone or more input/output devices, such as a keyboard, a pointing device,a scanner, or a networking device such as a switch or router, e.g.,through a network adapter.

The computing device 1400 may be implemented in a number of differentforms, as shown in the figure. For example, it may be implemented as astandard server 1420, or multiple times in a group of such servers. Inaddition, it may be implemented in a personal computer such as a laptopcomputer 1422. It may also be implemented as part of a rack serversystem 1424. Alternatively, components from the computing device 1400may be combined with other components in a mobile device (not shown),such as a mobile computing device 1450. Each of such devices may containone or more of the computing device 1400 and the mobile computing device1450, and an entire system may be made up of multiple computing devicescommunicating with each other.

The mobile computing device 1450 includes a processor 1452, a memory1464, an input/output device such as a display 1454, a communicationinterface 1466, and a transceiver 1468, among other components. Themobile computing device 1450 may also be provided with a storage device,such as a micro-drive or other device, to provide additional storage.Each of the processor 1452, the memory 1464, the display 1454, thecommunication interface 1466, and the transceiver 1468, areinterconnected using various buses, and several of the components may bemounted on a common motherboard or in other manners as appropriate.

The processor 1452 can execute instructions within the mobile computingdevice 1450, including instructions stored in the memory 1464. Theprocessor 1452 may be implemented as a chipset of chips that includeseparate and multiple analog and digital processors. The processor 1452may provide, for example, for coordination of the other components ofthe mobile computing device 1450, such as control of user interfaces,applications run by the mobile computing device 1450, and wirelesscommunication by the mobile computing device 1450.

The processor 1452 may communicate with a user through a controlinterface 1458 and a display interface 1456 coupled to the display 1454.The display 1454 may be, for example, a TFT (Thin-Film-Transistor LiquidCrystal Display) display or an OLED (Organic Light Emitting Diode)display, or other appropriate display technology. The display interface1456 may comprise appropriate circuitry for driving the display 1454 topresent graphical and other information to a user. The control interface1458 may receive commands from a user and convert them for submission tothe processor 1452. In addition, an external interface 1462 may providecommunication with the processor 1452, so as to enable near areacommunication of the mobile computing device 1450 with other devices.The external interface 1462 may provide, for example, for wiredcommunication in some implementations, or for wireless communication inother implementations, and multiple interfaces may also be used.

The memory 1464 stores information within the mobile computing device1450. The memory 1464 can be implemented as one or more of acomputer-readable medium or media, a volatile memory unit or units, or anon-volatile memory unit or units. An expansion memory 1474 may also beprovided and connected to the mobile computing device 1450 through anexpansion interface 1472, which may include, for example, a SIMM (SingleIn Line Memory Module) card interface. The expansion memory 1474 mayprovide extra storage space for the mobile computing device 1450, or mayalso store applications or other information for the mobile computingdevice 1450. Specifically, the expansion memory 1474 may includeinstructions to carry out or supplement the processes described above,and may include secure information also. Thus, for example, theexpansion memory 1474 may be provided as a security module for themobile computing device 1450, and may be programmed with instructionsthat permit secure use of the mobile computing device 1450. In addition,secure applications may be provided via the SIMM cards, along withadditional information, such as placing identifying information on theSIMM card in a non-hackable manner.

The memory may include, for example, flash memory and/or NVRAM memory(non-volatile random access memory), as discussed below. In someimplementations, instructions are stored in an information carrier and,when executed by one or more processing devices (for example, processor1452), perform one or more methods, such as those described above. Theinstructions can also be stored by one or more storage devices, such asone or more computer- or machine-readable mediums (for example, thememory 1464, the expansion memory 1474, or memory on the processor1452). In some implementations, the instructions can be received in apropagated signal, for example, over the transceiver 1468 or theexternal interface 1462.

The mobile computing device 1450 may communicate wirelessly through thecommunication interface 1466, which may include digital signalprocessing circuitry where necessary. The communication interface 1466may provide for communications under various modes or protocols, such asGSM voice calls (Global System for Mobile communications), SMS (ShortMessage Service), EMS (Enhanced Messaging Service), or MMS messaging(Multimedia Messaging Service), CDMA (code division multiple access),TDMA (time division multiple access), PDC (Personal Digital Cellular),WCDMA (Wideband Code Division Multiple Access), CDMA2000, or GPRS(General Packet Radio Service), among others. Such communication mayoccur, for example, through the transceiver 1468 using aradio-frequency. In addition, short-range communication may occur, suchas using a Bluetooth®, Wi-Fi™, or other such transceiver (not shown). Inaddition, a GPS (Global Positioning System) receiver module 1470 mayprovide additional navigation- and location-related wireless data to themobile computing device 1450, which may be used as appropriate byapplications running on the mobile computing device 1450.

The mobile computing device 1450 may also communicate audibly using anaudio codec 1460, which may receive spoken information from a user andconvert it to usable digital information. The audio codec 1460 maylikewise generate audible sound for a user, such as through a speaker,e.g., in a handset of the mobile computing device 1450. Such sound mayinclude sound from voice telephone calls, may include recorded sound(e.g., voice messages, music files, etc.) and may also include soundgenerated by applications operating on the mobile computing device 1450.

The mobile computing device 1450 may be implemented in a number ofdifferent forms, as shown in the figure. For example, it may beimplemented as a cellular telephone 1480. It may also be implemented aspart of a smart-phone 1482, personal digital assistant, or other similarmobile device.

Various implementations of the systems and techniques described here canbe realized in digital electronic circuitry, integrated circuitry,specially designed ASICs (application specific integrated circuits),computer hardware, firmware, software, and/or combinations thereof.These various implementations can include implementation in one or morecomputer programs that are executable and/or interpretable on aprogrammable system including at least one programmable processor, whichmay be special or general purpose, coupled to receive data andinstructions from, and to transmit data and instructions to, a storagesystem, at least one input device, and at least one output device.

These computer programs (also known as programs, software, softwareapplications or code) include machine instructions for a programmableprocessor, and can be implemented in a high-level procedural and/orobject-oriented programming language, and/or in assembly/machinelanguage. As used herein, the terms machine-readable medium andcomputer-readable medium refer to any computer program product,apparatus and/or device (e.g., magnetic discs, optical disks, memory,Programmable Logic Devices (PLDs)) used to provide machine instructionsand/or data to a programmable processor, including a machine-readablemedium that receives machine instructions as a machine-readable signal.The term machine-readable signal refers to any signal used to providemachine instructions and/or data to a programmable processor.

To provide for interaction with a user, the systems and techniquesdescribed here can be implemented on a computer having a display device(e.g., a CRT (cathode ray tube) or LCD (liquid crystal display) monitor)for displaying information to the user and a keyboard and a pointingdevice (e.g., a mouse or a trackball) by which the user can provideinput to the computer. Other kinds of devices can be used to provide forinteraction with a user as well; for example, feedback provided to theuser can be any form of sensory feedback (e.g., visual feedback,auditory feedback, or tactile feedback); and input from the user can bereceived in any form, including acoustic, speech, or tactile input.

The systems and techniques described here can be implemented in acomputing system that includes a back end component (e.g., as a dataserver), or that includes a middleware component (e.g., an applicationserver), or that includes a front end component (e.g., a client computerhaving a graphical user interface or a Web browser through which a usercan interact with an implementation of the systems and techniquesdescribed here), or any combination of such back end, middleware, orfront end components. The components of the system can be interconnectedby any form or medium of digital data communication (e.g., acommunication network). Examples of communication networks include alocal area network (LAN), a wide area network (WAN), and the Internet.

The computing system can include clients and servers. A client andserver are generally remote from each other and typically interactthrough a communication network. The relationship of client and serverarises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other.

In view of the structure, functions and apparatus of the systems andmethods described here, in some implementations, a system and method forperforming surgery with a robotic surgical system are provided. Havingdescribed certain implementations of methods and apparatus forsupporting a robotic surgical system, it will now become apparent to oneof skill in the art that other implementations incorporating theconcepts of the disclosure may be used. Therefore, the disclosure shouldnot be limited to certain implementations, but rather should be limitedonly by the spirit and scope of the following claims.

Throughout the description, where apparatus and systems are described ashaving, including, or comprising specific components, or where processesand methods are described as having, including, or comprising specificsteps, it is contemplated that, additionally, there are apparatus, andsystems of the disclosed technology that consist essentially of, orconsist of, the recited components, and that there are processes andmethods according to the disclosed technology that consist essentiallyof, or consist of, the recited processing steps.

It should be understood that the order of steps or order for performingcertain action is immaterial so long as the disclosed technology remainsoperable. Moreover, two or more steps or actions may be conductedsimultaneously.

What is claimed is:
 1. A method of performing surgery with a roboticsurgical system, the method comprising: moving a mobile carttransporting a robotic surgical system comprising a robotic arm inproximity to an operating table, wherein the robotic arm has an endeffector comprising a surgical instrument guide for guiding a surgicalinstrument, the surgical instrument guide having an internal handle anda sterile handle, wherein the sterile handle comprises: a tighteningsleeve comprising a hollow tubular structure having a first open end,said structure defining an axis along which the internal handle of thesurgical instrument guide may be inserted, the tightening sleevecomprising two or more openings along a length of the tightening sleeveallowing the tightening sleeve to mechanically flex under tension,wherein no part of the surgical instrument is received in the tighteningsleeve, a sterile handle housing comprising a hollow tubular structurehaving a first open end, said structure of the sterile handle housingdefining an axis along which the tightening sleeve may be inserted, atightening nut coupled to the sterile handle housing and comprising athread on an interior of the tightening nut, wherein the tightening nutis configured to engage a thread on exterior of the tightening sleeveand thereby tighten the tightening sleeve such that a diameter of aportion of the tightening sleeve decreases and securely holds a portionof the internal handle of the surgical instrument guide, and anelectrical assembly comprising one or more input devices for commandingthe robotic surgical system; stabilizing the mobile cart; maneuveringthe robotic arm to a desired position to align an axis defined by thesurgical instrument guide at a desired trajectory in relation to apatient situation; fixing the position of the robotic arm; andmaneuvering a surgical instrument in a manner that is constrained by thesurgical instrument guide.
 2. The method of claim 1, wherein thesurgical instrument guide is configured to at least one of hold andrestrict movement of a second surgical instrument therethrough.
 3. Themethod of claim 2, wherein the surgical instrument is a drill bit. 4.The method of claim 3, wherein the surgical instrument guide is a drillbit guide.
 5. The method of claim 4, further comprising: maneuvering thedrill bit through the drill bit guide.
 6. The method of claim 1, furthercomprising: maneuvering the surgical instrument through the surgicalinstrument guide.
 7. The method of claim 1, wherein the robotic surgicalsystem is for use in spinal surgery.
 8. The method of claim 1, whereinthe one or more input devices comprises two or more buttons configuredto enable a user to active one or more of the two or more buttons toplace the robotic surgical system in one of a rotation mode, atranslation mode, or course positioning mode that allows translation androtation movements.
 9. The method of claim 8, wherein, upon selection ofa first button of the two or more buttons, the robotic surgical systemis in the rotation mode, upon selection of a second button of the two ormore buttons, the robotic surgical system is in the translation mode,and upon selection of both the first and second buttons, the roboticsurgical system is in the combined translation and rotation mode. 10.The method of claim 1, wherein the surgical instrument guide includes aguide tube having an axis which is disposed at an angle to the axis ofthe internal handle.
 11. The method of claim 1, wherein the sterilehandle comprises one or more sensors configured to detect a presence ofa surgeon's hand in proximity to the sterile handle.
 12. The method ofclaim 1, wherein the sterile handle is configured to be attacheddirectly or indirectly to an end-effector of the robotic surgicalsystem.
 13. The method of claim 1, wherein the robotic surgical systemis configured to allow robotically-assisted or unassisted positioningand/or movement of the sterile handle by a user with at least sixdegrees of freedom, wherein the six degrees of freedom are three degreesof translations and three degrees of rotations.
 14. The method of claim1, wherein the sterile handle is at least one of completely or partiallydisposable.
 15. The method of claim 1, wherein the surgical instrumentguide is configured to be used to guide a screw implant and a tissueprotector.
 16. The method of claim 1, wherein the sterile handle isremovably attached to the robotic arm.
 17. The method of claim 16,wherein the axis can be aligned with the desired trajectory in relationto the patient situation via the sterile handle.
 18. The method of claim17, wherein stabilizing the mobile cart comprises extracting one or morerigid legs on the mobile cart such that the mobile cart rests on the oneor more rigid legs of the mobile cart.
 19. The method of claim 18,wherein stabilizing the mobile cart comprises retracting one or morewheels on the mobile cart such that the mobile cart rests on one or morerigid legs of the mobile cart.
 20. A method of performing surgery with arobotic surgical system, the method comprising: moving a mobile carttransporting a robotic surgical system comprising a robotic arm, whereinthe robotic arm has an end effector comprising a surgical instrumentguide for guiding a surgical instrument, the surgical instrument guidehaving an internal handle and a sterile handle, wherein the sterilehandle comprises: a tightening sleeve comprising a hollow tubularstructure having a first open end, said structure defining an axis alongwhich the internal handle of the surgical instrument guide may beinserted, the tightening sleeve configured to mechanically flex undertension, wherein no part of the surgical instrument is received in thetightening sleeve, a sterile handle housing comprising a hollow tubularstructure having a first open end, said structure of the sterile handlehousing defining an axis along which the tightening sleeve may beinserted, a tightening nut coupled to the sterile handle housing andcomprising a thread on an interior of the tightening nut, wherein thetightening nut is configured to engage a thread on exterior of thetightening sleeve and thereby tighten the tightening sleeve such that adiameter of a portion of the tightening sleeve decreases and securelyholds a portion of the internal handle of the surgical instrument guide,and an electrical assembly comprising one or more input devices forcommanding the robotic surgical system; stabilizing the mobile cart;maneuvering the robotic arm to a desired position to align an axisdefined by the surgical instrument guide at a desired trajectory inrelation to a patient situation.